Hospitals hiking cost on the poor due to … ObamaCare

posted at 2:41 pm on May 27, 2014 by Ed Morrissey

There are multiple levels of irony in this New York Times report on the impact of ObamaCare on poor patients in the nation’s hospitals. Congress demanded the power to revamp the health-insurance industry and expand Medicaid in order to help the poor get better medical care for less money. In reality, the opposite appears to be happening, as hospitals attempt to force the poor into ObamaCare:

Hospital systems around the country have started scaling back financial assistance for lower- and middle-income people without health insurance, hoping to push them into signing up for coverage through the new online marketplaces created under the Affordable Care Act.

The trend is troubling to advocates for the uninsured, who say raising fees will inevitably cause some to skip care rather than buy insurance that they consider unaffordable. Though the number of hospitals tightening access to free or discounted care appears limited so far, many say they are considering doing so, and experts predict that stricter policies will become increasingly common.

Why did this unintended consequence occur? In part, because ObamaCare penalizes hospitals for extending charitable assistance:

Driving the new policies is the cost of charity care, which is partly covered by government but remains a burden for many hospitals. The new law also reduces federal aid to hospitals that treat large numbers of poor and uninsured people, creating an additional pressure on some to restrict charity care.

Got that? The law that supposedly answered the fierce urgency of now in assisting the poor penalizes providers for, er, assisting the poor. They want to force low-income patients to either enroll in an ObamaCare plan, or to accept Medicaid coverage — even though fewer and fewer providers will see patients with either coverage.

This sets up a damned-if-they-do conundrum for hospitals, which have been the front line of caring for the poor:

“Do we allow our charity care programs to kick in if people are unwilling to sign up?” said Nancy M. Schlichting, chief executive of the Henry Ford Health System in Detroit. “Our inclination is to say we will not, because it just seems that that defeats the purpose of what the Affordable Care Act has put in place.”

But advocates for the uninsured point out that many Americans avoided obtaining coverage in the inaugural enrollment period of the Affordable Care Act this year because they found the plans too expensive, even with subsidies. Many uninsured people also remain unaware of the new insurance options, And immigrants who are in the country illegally are not even eligible to apply.

Most hospitals are not reducing charitable service to those who fall under the federal poverty level, the NYT’s Abby Goodnough reports. It’s a different story, though, for those who earn between 200-400% of the federal poverty level, where Medicaid eligibility ends and the mandate requires everyone to buy coverage and accept subsidies. Thanks to the new federal restrictions on charity, hospitals have to focus their efforts on the neediest patients — and everyone else gets stuck with the bill.

These are the kinds of things that one might have foreseen had Congress not been in such a rush to pass a bill without carefully reading through its language. On that point, CNS News and the Daily Surge note a moment of supreme irony last week in the debate over how to fix the VA:

“We have not held a hearing on this legislation. And some of us are old-fashioned enough to know that maybe folks in the Senate might want to know what is in the bill before we voted on it.”

Nope, those aren’t the words of a Republican shaming the Democrats during the Obamacare debate–it’s none other than Bernie Sanders! Taken from the Senate floor just a couple of days ago, the “Independent” senator from Vermont is suddenly urging caution when it comes to passing bills. Why? Well, it was barely two two weeks ago that we told you Bernie has been quivering in his Socialist boots over the VA scandal. As Chairman of the Veterans Affairs Committee, the effects of a probe into the misconduct at VA hospitals has a good chance of showering a pot full of slop onto him personally, and in a tense midterm election year, he obviously does NOT want to be associated with this scandal on any level.

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Each provider has their own payer mix dependent on the business expenses + profit margin desired
They achieved the goals on revenues by utilizing a mix of patient reimbursements from the three categories above.
Gains from traditional private health insurance reimbursements were used to cover losses from lower paying patients.

Obamacare changed all that. Traditional private health insurance reimbursements are decreasing. Doctors don’t have that leeway they’ve relied on times past to cover the lower paying reimbursement. At the same time, operating costs are increasing, with a significant amount of it due to reg measures in Obamacare.

This is putting the squeeze on a lot of doctors, causing them to sell out their business, close the doors, retire, etc.

So there’s more to it from that perspective than from the consumer’s viewpoint.

1. Complete fail of healthcare.gov and needs $1 billion to correct.
2. Still no security on healthcare.gov
3. Still no backend healthcare.gov
4. Oregon health care site crashed and burned up 130 million dollars
5. Maryland health care site crashed and burned up 140 million dollars.
6. Hawaii health care site crashed and burned up 150 million dollars.
7.2 to 1 people believe that Obama-democrat care will make things worse.
8. 7-8 million people lose their health insurance because of Obama-democrat Care.
9. Mandates put off until after 2014 elections.
10. UNIONS against Obama-democrat Care.

I could keep going on about all of the success stories about Obama-democrat care but I’m getting tired.

You don’t think a +5% improvement over a few months is significant? Seems like it to me.

Tlaloc on May 27, 2014 at 3:42 PM

Funny, you say this is significant, how about our debt? How about unemployment, how about energy costs?

20% of the economy has a bump of +5%, while 80% is still in ruins.

A +5% is only good if it is sustained and continues to improve, but since you only choose to select a recent improvement, when it drops back down, you will surely say how horrible it is, right? No, of course not.

The only stats that are of interest to you, are the ones that support your contention.

around january it had a low of -15.2 favorability. Since then the number has moved 5 points in the positive direction to be around -10 now. Which is exactly what I said.

Don’t blame you inability to read on me.

Tlaloc on May 27, 2014 at 3:33 PM

Looks to me like the actual RCP average for the 4/23 – 5/24 timeframe shows a net disapproval of ‘11.4’, and not the “10” you claim. Of course, you are welcome to point out the error in my math (and reading comprehension skills) as compared to yours…..Thanks!

1. The amount that “I cover” for many poor & middle-income is going UP under Obamacare, as deductibles etc. rise.

2. For folks in a CMS program (Medicaid, Medicare) the patient usually covers very little. The gov. tells docs & hospitals “Here’s what we’ll pay for that medicine/ procedure. It doesn’t make you profitable? Sorry ’bout that…”

Of course the number will drop, just like when you give anything away, the person receiving it benefits…when you rob Peter to pay Paul, Paul never complains.

However, how many have been forced off of their plans, by order of their government? How many have been forced to lose their doctors, by order of the government?

Stealing the rights from some, to give to others is not an act to rejoice…taking freedoms and giving special privileges to others is not, except in a liberal mind, what our country was founded on.

And when people like you, who live off of the government, have an opportunity to steal what others have worked for, they will do it and claim that it is “good”.

No different than if your parents left the garage door open, and someone needed a lawnmower, and your parents had two of them, it is perfectly alright for that neighbor to take that extra lawn mower, right?

When you grow up, and move out of the house, you may understand, assuming you have a job.

Looks to me like the actual RCP average for the 4/23 – 5/24 timeframe shows a net disapproval of ’11.4′, and not the “10″ you claim. Of course, you are welcome to point out the error in my math (and reading comprehension skills) as compared to yours…..Thanks!

tanked59 on May 27, 2014 at 4:20 PM

It’s been hovering around 10 for the last few weeks. Just today it dipped back to 11. We’ll have to wait to see if that marks an actual change or just some noise.

Catz also wrote that Oracle merely assisted Oregon on the exchange project, was not the project manager or systems integrator, and the company was hampered by the state’s lack of skills and ability in performing those duties.

Thanks. One or two other questions. If you don’t mind. You may have already answered these before, if so, my apologies. Are you currently covered by a healthcare provider trough ObamaCare? Are you a US citizen?

No different than if your parents left the garage door open, and someone needed a lawnmower, and your parents had two of them, it is perfectly alright for that neighbor to take that extra lawn mower, right?

When you grow up, and move out of the house, you may understand, assuming you have a job.

right2bright on May 27, 2014 at 4:26 PM

Maybe. Maybe someday you’ll stop being okay with letting people die just because they’re poor. Who knows what may happen in the future.

Thanks. One or two other questions. If you don’t mind. You may have already answered these before, if so, my apologies. Are you currently covered by a healthcare provider trough ObamaCare? Are you a US citizen?

Bmore on May 27, 2014 at 4:29 PM

1) No, already had coverage, I talked with the wife about looking into an ACA plan but the Oregon site was such a mess and we get a very good plan through my job that it wasn’t a pressing need.

I believe you will see that the reduction in uninsured stats as a percentage is due to forcing people onto medicaid, for which they were always eligible. If you look at the actual people in exchange plans as part of a covered cohort I believe the percentage of uninsured is actually higher – and the absolute number still seems to be stuck around 40M, which was the number thrown out at the start of the whole debate.

You first posit that “poor people die” because they do not have access to healthcare:

Maybe someday you’ll stop being okay with letting people die just because they’re poor. Who knows what may happen in the future.

Tlaloc on May 27, 2014 at 4:29 PM

You then acknowledge awareness of a decades-old law that expressly forbids denying care for anyone at significant risk for mortality or significant morbidity:

I’m well aware of EMTALA, if you think that emergency rooms are the only health care that saves lives you’re fooling yourself.

Tlaloc on May 27, 2014 at 4:33 PM

And, of course, the uninsured patient who presents in the ER and needs treatment to save life & limb is then admitted to the (generally adjacent) acute care hospital until stabilized enough to be discharged or transferred.

I would think, now that I know about it, that the intent in PPACA is, at least, two things:

1. Force uninsured into the PPACA by denying them charitable (such as it is) health care.

This follows from the fact that an expanded risk pool [generally?] means that the average risk per member goes down. if pool behavior does not change. That means that the cost or premium per member should go down, supposedly making the policy more affordable. But, the problem with respect to costs is that the minimum required coverages have been expanded by regulation not by consumer demand (where consumers know that getting additional coverage for themselves would cost them more) so the policies tend to cost more and are thereby, generally, less affordable.

2. A secondary, probably unspoken aspect, is that the restrictions (as noted in the posting) tend to degrade voluntary charitable health care and make it more of a government function to provide health insurance. By degrading charitable care, the government can then become the only game in town. Which is pretty much what Liberal/Progressives want.

The rate of the uninsured has plummeted to what Bush had before Obama came into power. And to think that it only cost couple of trillion dollars and threw 8 million people off of their own insurance.

WINNING!!!!!

jukin3 on May 27, 2014 at 4:37 PM

It would be a surprise if a decline in the uninsured rate hadn’t happened. When you give Medicaid to a whole new group of people, offer subsidies to a huge number of other lower-income people, and put everyone else under the threat of penalty for not getting insurance, the needle is bound to move.

It’s a feature not a bug that the PPACA eliminates programs to help the uninsured while offering the uninsured a way to become insured so as to reduce the freeloader problem.

Tlaloc on May 27, 2014 at 3:08 PM

You do realize, I hope, that you’re saying the law is punishing those who help people pay for their own health care, as a means of reducing the number of people not paying for their own health care. And that it’s a positive.

those who didn’t get medicaid subsidies…

Tlaloc on May 27, 2014 at 3:18 PM

Medicaid is neither a subsidy, nor a plan for which people have premiums subject to a subsidy. It is government-funded.

That’s a less than subtle hint that you might want to stop poo-pooing polls just because they don’t say what you want them to say.

Tlaloc on May 27, 2014 at 4:02 PM

This from a guy who calls a 10% deficit a positive sign.

I guess you just can’t trust the private market to do anything right, huh? ;)

Tlaloc on May 27, 2014 at 4:09 PM

The private market sold its own insurance online just fine for years prior to ACA. It is the government’s siloed information systems combined with its need to deceive people about the true cost of their insurance by insisting on the use of subsidized numbers and not real quotes, that is the root cause of pretty much every exchange failure to date.

A big decline in the number of uninsured.

Tlaloc on May 27, 2014 at 4:10 PM

That came on the heels of a big increase in same, because we were in a recession. And yet you don’t bother to question why 2008 is the benchmark for this measurement, even though the correlation seems pretty obvious. You also neglect the Rand survey which demonstrated that the bulk of newly insured came not from Obamacare enrollees but addition to the employer-supported rolls.

Maybe. Maybe someday you’ll stop being okay with letting people die just because they’re poor.

Tlaloc on May 27, 2014 at 4:29 PM

And now we’re back to the threefold fallacy of a). ridiculous claims about people “dying because they’re poor”, b). emotional arguments in lieu of rational thought, and c). trying to marginalize the views of others by attacking their character.

if you think that emergency rooms are the only health care that saves lives you’re fooling yourself.

Tlaloc on May 27, 2014 at 4:33 PM

For the last five years, all we’ve heard from the ACA standard-bearers is that the ER is the only time anyone ever goes to get health care unless they’re insured. Don’t fault others for the poor logic that others foisted on them.

1. Complete fail of healthcare.gov and needs $1 billion to correct.
2. Still no security on healthcare.gov
3. Still no backend healthcare.gov
4. Oregon health care site crashed and burned up 130 million dollars
5. Maryland health care site crashed and burned up 140 million dollars.
6. Hawaii health care site crashed and burned up 150 million dollars.
7.2 to 1 people believe that Obama-democrat care will make things worse.
8. 7-8 million people lose their health insurance because of Obama-democrat Care.
9. Mandates put off until after 2014 elections.
10. UNIONS against Obama-democrat Care.

I could keep going on about all of the success stories about Obama-democrat care but I’m getting tired.

jukin3 on May 27, 2014 at 4:15 PM

You were supposed to forget that the backends of those websites are still broken.

But I’m glad you reminded us. Gives me an occasion to post this golden oldie:

The typical margin of error in polls is between 3% and 3.5%. If you can prove that stat to be flat wrong, please do so. But elsewhere you cite Kaiser and/or Gallup, and both of their most recent polls on the ACA have a 3% margin of error. But hey, feel free to prove me “flat wrong”.

I guess you just can’t trust the private market to do anything right, huh? ;)
Tlaloc on May 27, 2014 at 4:09 PM

How do you go thru life butthurt stupid?

You seriously believe that Oracle which made billions being state of art in database et al couldn’t do healthcare right because it was incompetent? The technology required by OboobiCare is market proven over decades. These companies are used to dealing in four-9s whereas the govt is used to blowing 10% or more in fraud waste and abuse without even flinching. Stats that would put any company out of business in a heartbeat.

What gives Oracle, Xerox, CGI and other leading tech companies the fits are inane and purely political specifications with no basis in logic or even best practices.

In other words, not even the best company can make a deformed peg like OC fit into a round hole or even a square one. If you want OC to suceed then you must repeal and replace with policies that make sense.

One more example of Democrat disdain for the poor, saying “Get a job!”, and doing everything in their power to ensure there are no jobs to be had.

That being said, this does seem over the top even for them, to penalize those who want to provide charitable help for the poor. I guess they’ve finally recognized that Republicans are the ones who are the most generous in giving to charities, so in their eyes charitable giving is now evil. It does provide hope to people that they might break the yoke of government bondage, so I can see how they would object to that.

Next they will probably start threatening to take away tax-exempt status for churches who spend too much of their budget on benevolence.

Next they will probably start threatening to take away tax-exempt status for churches who spend too much of their budget on benevolence.
s1im on May 27, 2014 at 8:31 PM

That’s always have been the progressive plan. None may be charitable unless the gubmint has a hand in serving. They used “food poisoning” as the excuse to elbow out churches from passing out sandwiches and soup. They forced rescue missions to separate their charity from their ministry. They even shutdown adoption agencies – “for the ghey couples” so that adoption becomes less likely for anyone and abortion to be the preferred way out fron motherhood.

Oh count the ways that charity is snuffed for the greater good – dependence on the state.

Tlaloc, I’m a pharmacist and I haven’t seen any poor people dying from lack of medical care – except for our veterans in the socialized VA medical system.

My husband is retired army and I can tell you from experience that the medical care in the socialized military hospitals and clinics isn’t much, if any, better. While my husband was stationed in Germany an officer we knew of died due to poor military medical care during and immediately after childbirth. She basically bled to death. My husband and I wouldn’t have dare taken our children to the military medical facilities.